GUIDE 



FOR 



THE CLINICAL EXAMINATION 
OF CHILDREN 



BY 

H. G. HARDT, M. D. 

CLARA HARRISON TOWN, Ph. D. 




THE LINCOLN STATE SCHOOL & COLONY 
H. G.Hardt, M. D., Superintendent 



LINCOLN, ILLINOIS. 
1912 



A GUIDE 



FOR 



THE CLINICAL EXAMINATION 
OF CHILDREN 



BY 

H. G. HARDX M. D. 

CLARA HARRISON TOWN. Ph. D. 




THE LINCOLN STATE SCHOOL & COLONY 
H. G. Hardt, M. D., Superintendent 



LINCOLN. ILLINOIS. 
1912 



^ 



V 






Mm 17, ^9U 



^ 



I 



Contents. 



* PACE 

Introduction I ^ 

History 15 

Teachers' or Attendants Record 19 

Physical Examination 23 

Post Mortem Examination 32 

Mental Diagnosis, Tests foi- 35 

Mental Analysis, Tests for 69 



A Guide for the Clinical Examination 
of Children 



INTRODUCTION 

This syllabus is designed to furnish a guide for the examina- 
tion and analytic study of atypical individuals, children primarily. 
It is divided into five parts, the first presenting an outline for the 
record of the subject's history, the second an outline for the re- 
cording of his characteristics and abilities as manifested during the 
first month or so of his institution life, the third an outline for the 
physical examination, the fourth an outline for the post-mortem 
examination, and the fifth explicit directions for the mental ex- 
amination. 

The mental examination is divided into two parts. The first 
an examination for the diagnosis, the second an intensive examina- 
tion for the purpose of mental analysis. 

The examination for diagnosis is made by means of the Binet- 
Simon Measuring Scale of the Intelligence. The Binet Scale is the 
most highly perfected system of tests for diagnostic purposes. It 
is the only series of tests of any description which has been so 
adapted to an established classification as to give absolute uni- 
formity of diagijosis in the grading of feeble minded children. The 
sub-groups of the feeble minded, the idiot, the imbecile, and the 
moron, are, without it, ill-defmed and depend largely on the per- 
sonal equation of the examiner, with it they depend absolutely 
upon three great planes of language development; the idiots are 
limited almost entirely to gesture, the imbeciles to spoken lan- 
guage, while the morons are capable of learning to read and write. 
The series is moreover the only series in which mental ability and 
age are correlated, and it thus gives us not only a fair standard for 
the examination of the partially developed child mind, but also a 
means of determining the actual mental retardation of any child 
whose exact age is known. The age correlation given by the scale, 
the hierarchy of tests there presented, has been submitted to ex- 
perimental trial by Binet and other investigators and the results 
confirm the norms given as true norms. 



12 A GUIDE FOR THE CLINICAL 

The scale consists of a number of groups of tests, each group 
assigned to a certain age at which average children are capable of 
passing it successfully. The child's intelligence level or mental 
age is determined by the highest group all the tests in which he 
passes. To allow for unevenness of development, an extra year of 
mental age is added for every five tests passed in groups superior 
to that group of which all tests are passed. No child is considered 
as belonging to the feeble minded group unless his mental age is at 
least three years in arrear of his real age. If his retardatioA 
amounts to this he is graded an idiot, an imbecile, or a moron, ac- 
cording to his mental age; idiot if this mental age is one or two, 
imbecile if it is three, four, five, six, or seven, and moron if it is 
eight, nine, ten, eleven or twelve. Higher than twelve years the 
feeble minded child seems not to develop. The system of notation 
used in recording the results of the tests is : + for success — for 
failure, ! for absurd responses. Partial credit is occasionally re- 
corded by %. 

No one should attempt to make these tests without a thorough 
study of the directions for so doing published by Binet and Simon 
in L'Annee Psychologique 1908, and La Bulletin de la Societe libre 
pour I'Etude psychologique de I'Enfant, April 191 L The authors 
are most emphatic in their statements that the Scale, in spite of its 
simplicity, is not a mechanical one, and the results obtained when 
it is used by untrained individuals are of no value for scientific 
purposes. 

The second part of the mental examination consists of a series 
of tests designed to thoroughly explore the mental life of a devel- 
oped individual. Tests are all standard ones selected from the 
literature in the course of clinical work with abnormal subjects. 
Many of them will be found inapplicable to low grade mentality as 
of course the more difficult of the Binet tests also are. The series 
of tests is divided into four sections in accordance with the re- 
cognition of three fundamental mental processes; sensation, repro- 
ductive memory, and apperception, and their final expression 
volitional motor ability. Of course none of these processes can be 
absolutely isolated in experiment, sensation will always merge in- 
to perception, and perception into apperception. The tests used, 
the material required, and the directions for testing, are presented 
in parallel columns to facilitate their use. 




Models of Ear, Eye anu Brain. 



EXAMINATION OF CHILDREN 



15 



History. 



(Information to be obtained from parents 
others who know the family well.) 

General. 



family physician, and 



Child's full name and present address. 

Name and address of parents or guardian. 

Date of birth of child, or, if unknown, apparent age. 

Birthplace of child, of father, of mother. 

Occupation of father and mother. 

Heredity. 




Notes : — 

What other relatives of father or mother belong under 6, 8, or 
1 1, giving details. 

Which of the above or other blood relatives had any of the 
following conditions, specifying and giving details: Drug habit, 
vagrancy, special peculiarities of mind or body, hypochondria, 



16 A GUIDE FOR THE CLINICAL 

sexperversion, defect of 'sight, hearing, or speech (stating whether 
congenital or acquired^ meningitis or brain fever (stating at what 
age) spasms or convulsions, chorea, hysteria, neurasthenia, par- 
allysis, other nervous diseases or conditions, apoplexy, heart disease, 
sudden death, diphtheria, typhoid, scarlet fever, small pox, goiter, 
other severe disease or defect, serious operations, confinement in 
hospitals or institutions (what and why?), miscarriages (;number 
and cause?), cancer, suicide. 

Parents : Father's parents : Mother's parents : 

Brothers : Sisters : Other near relatives : 

Growth and Retardation of Child. 

Order of birth. Weight at birth. Born at full 

term? 

Deficiency or peculiarity at birth. What? 

At what age and how were peculiarities first manifested? 

At what age did the child-recognize persons? Sit 

alone. 

Stand alone? Walk alone? Use spoon? Get 

first teeth? 

Use first words? First short sentences? Acquire 

tidy habits? 

Know most of his letters? Get second teeth? Start 

to school? 

What progress at school? Stopped at what age and 

grade? ' Why? 

Reads how? Writes how? Counts to? Adds. 

Multiplies. Divides. Weight. Height. 

Medical History. 

What was the condition of the mother's health or habits 
during gestation? 

Was she mentally troubled? How and why? 

Was labor long and difficult? Instruments used? 

Anesthetics? 

Did child show deficient animation or vitality at birth? 

Difficulty in breathing or nursing? 

Any indications of specific disease? What? 

Malnutrition in infancy? Rickets? 

What troubles, if any in teething? 

Has child had the following, stating age and severity: 

Meningitis or brain fever? Diphtheria? Typhoid 



EXAMINATION OF CHILDREN ' 17 

fever? 

Scarlet fever? Whooping cough? Measles? 

Chorea or St. Vitus dance? Tuberculosis? Scrofula? 

Sleepwalking? Night terrors? Nervous attacks? 

Describe. 

Paralysis? Describe. What disease or trouble of 

eyes? 

Of ears? Of nose and throat? Of skin? 

Has child had epilepsy? Fainting spells or spasms?- 

State frequency of convulsions, if any, and date of last. 

What imperfections of speech? Of gait and movement? 

What troubles, mental or physical, at puberty? 

At the monthly periods? 

Has the child been pronounced insane or feeble-minded? 

When, and by whom? 

Name any other diseases or affections that child has had?. 

Has been in what hospitals or other institutions, and why? 

Has undergone what operations? What severe accidents? 

When was the child last vaccinated? With what results? 

Has the child recently been exposed to infection? 
^ffifp (iisoRSP 

Give name and address of physician who attended at birth of 

child. 

Name and address of present family physician. 

Environment and Personal History. 

Has the family always been self-supporting? Cleanly? 

How was the child treated by. and what was the influence of 

the father? , .^^ 

Of the mother? Of step-parent or others charged with 

its care? 

Was the child indulged, maltreated, secluded? 

How many persons in the home? How many rooms? 

Was the liome tranquil or disturbed? Moral condition 

of the home? 

What was the influence of child's associates? • 

Of associates of the opposite sex? 

What have been the child's chief interests? 

In what ways has child been useful? 

How does the child spend its leisure time? 

Child's .deportment and the impression made, at school? 
At work? 



18 ' A GUIDE FOR THE CLINICAL 

How long has child worked? At what work and 

wages? . 

How does he care for money or valuables given or earned? 

Capacities, Habits and Character. 

To what extent, if at all, has child used alcoholic drinks? 
Tobacco? Cocaine or other drugs? 

What harmful personal habits does he have? 

Does he run away from home? Ever hide or destroy 

things? 

What is his attitude to animals? To playmates? To 

parents? 

Is child's memory good? What evidence of it? 

What does he learn rapidly other than school work? 

Does he pay attention well? Obey well? Feed himself? 

Dress and undress? Tie a shoe lace? Have morbid 

fears? 

Queer ideas? Specify. Is child attentive to calls of 

nature? 

Does he sleep well? How many hours? 

Underscore words that describe child: Trustworthy, in- 

dustrious, untruthful, lazy, seclusive, moody, cheerful, sly, selfish, 
slovenly, neat, ill-tempered, violent, excitable, thieving, sissy or 
cry-baby, emotional, affectionate, unfeeling, fighter, fits of temper, 
obstinate, anxiouS;, fearful, complaining, gossipy, laugh or cry 
without cause, very changeable, proud (of what?), resentful. 

What cause has been assigned for deficiency, if any is 
present? 

Of what delinquencies has child been guilty? Give details? 

What other exceptional behavior has been noted? 

What punishments have been inflicted? 

What is child's attitude toward correction? 

What efforts have been made to help child, when, and by 
whom ? 



EXAMINATION OF CHILDREN. 19 



Teachers' or Attendants' Record. 



The child should be under observation for at least a month 
before this blank is filled.) 

Observation data concerning the habits, capacities, and men- 
tality of Reported by Date 

Habits and Characteristics. 

Is the child very nervous? When, and how shown? 

Is he noisy? Mischievous? How? 

Does he run or stray. away? Often? Get lost? 
When? 

Can he see well? Hear well? Read outside of school 

work? What? 

Does he wet day clothing? Soil day clothing? 

What unfortunate habits, sexual or otherwise? 

Does he complain much? Of what? 

In what way is the child most troublesome or faulty? 

In what way does he most differ, if at all, from normal chil- 
dren ? 

Describe his habitual position in study or recitation. 

Underline the words that correctly describe the child: 
Cheerful. Morose. Quarrelsome. Active. Obsti- 

nate. Sensitive. Moody, Good-tempered. Excitable. 

Changeable in mood or character. Sly. ' Resentful. Lazy. 

Slovenly. Neat. Cleanly. Proud. Of what? Silent. 

Talkative. Obedient. Generally destructive. Heedless of 

danger. Destroys clothing. Destroys furniture. Cries with- 

out cause. Laughs without cause. Mouth usually open. 

Emotional. Lacking in feeling. Anxious. Impulsive. 

Lacks self-control. Easily managed. Superstitious. Ap- 

prehensive or fearful. Fears what? Cranky. Humorous. 

Very stupid. Selfish. Generous. Gossipy. 

Capacities and Incapacities. 

Does he help care for other children? 



20 A GUIDE FOR THE CLINICAL 

Need careful and close supervision? 

Can he talk? Much? Distinctly? Can he do er- 

rands? 

Does he know some letters? How many objects can he 

count? 

Can he add? Multiply? Divide? 

Reads how, in Reader? Understands '^hat he reads? 

Writes fairly. Spells fairly. Copies dictation how? 

badly. badly, 

well. well. 

Draws fairly. Plays fairly, on what musical instrument? 
badly. badly, 

well. well. 

Sing fairly. What kind of songs or music? 

badly, 
well. 

What and how well can child do in manual or industrial 
work? 

In kindergarten? In gymnastics? In athletics gen- 

erally? 

In entertainment work? Details. 

What other studies or work is he engaged in, and what pro- 
gress in each? 

In what does he do his best work? His poorest? 

What is he "good at" in any direction? 

Are there times when he does much better or worse than 
usual? 

How account for these variations? What prevents his 

doing better? 

What noticeable defects has he? 

Intelligence and Perception. 

Can he tie an ordinary knot? Understand and obey com- 

mands? 

Tell time? Take care of apparatus and furniture? 

How complicated are machines or tools which he can use? 

How well adapt himself to changed schedule or other new 
conditions? 

Does he think of what to do in emergencies, or in play? 
Examples. 

What other evidences of intelligence or stupidity? 

Ever imagine that he sees things? That he hears voices 

or other sounds? 



EXAMINATION OF GHILEREN 21 

Movements and Play. 

Can he throw and catch a ball? Dance? How well? 

How does he walk? Is he very awkward? Very ac- 

tive? 

Left-handed? Use both hands equally well? Quick 

or slow? 

What automatic movemejits or mannerisms has he, and 
when? 

How does he go up and down stairs? 

Play much, or at all? How? How long at one thing? 

What, for example? Does he build blocks? Collect 

things? 

Excel or lead others in play? Play over past exper- 

iences? 

"Make believe" much in play? Play alone or with others, 

usually? 

Learning, Interests, Imitation and Memory. 

Name the main interests noticed in this child, underlining 
the strongest. 

Does he learn new work easily? Remember it well? 

Learn "pieces" easily? Remember them well? 

Talk or seem to think much of old-time experiences? 

Of recent experiences? Is he very forgetful? 

What does he imitate? How much and how well? 

Mechanically or with understanding? 

How much progress or decline have you seen in him, in how 
long? 

Does he stick to tasks well? Willing and tries? 

Is he easily confused? When and how? 

Do you think he will improve, stand still, or go back? 

Morals. 

Is he cruel? Profane? Obscene? Deceitful? 

Thieving? 

Untruthful? Lacking in shame or modesty? 

Ever -violent to others? Show sense of duty? 

Of right and wrong, or remorse? 

What evidences of interest in religion? Is he trust- 

worthy? 

Of what immoral acts is the child frequently or sometimes 
guilty? 



22 A GUIDE FOR THE CLINICAL ' 

Other Social Relations. 

Is the child easily led or persuaded? By whom? 

Over-dependent on others? Like to have and show 

authority? 

Is he confiding? . Chummy? Timid? 

Bashful? Affectionate? Sociable? Sympathetic? 

What is his attitude toward hig parents? 

Toward his brothers or sisters? Toward strangers? 

Toward animals or pets? Does he get on well with other 

children? Why not? Is he a sissy or cry-baby? 



EXAMINATION OF CHILDREN 23 



Physical Examination. 

I. 

General Anthropological Data. 

1. Height. 2. Stretch of arms. 3. Weight. 4. Skull 
measurements (circumference at level of occipital protuberance 
and glabella, greatest lateral width). Rieger tracing if necessary. 
5. Malformations. 
.^Underscore those found, in list below, and add any others.) 

Head: — ^Microcephalic, macrocephalic, hydrocephalic, asym- 
metrical. 

Face: — Prognathous, immobile, inferior maxillary small, 
large, superior maxillary small, nasal bones sunken, forehead 
retreating, narrow; face asymmetrical as to forehead, nose, eyes, 
ears, mouth. 

Nose: — Much deHocted, septum abnormal, base of nose broad, 
nostrils open forward. 

Lips: — Hare-lip, lips very thick, very thin, fissured above, 
below, very long, very short. 

Teeth: — Hutchinson's, persisting milk teeth, serrated, pointed 
or notched, chalky, impacted, irregular in shape or arrangement, 
decayed, rachitic. 

Soft Palate: — Twisted R. L. Response of azygos muscle. 

Hard Palate: — Cleft, V-shaped, semi-V-shaped, saddle-shape, 
high, narrow. 

Eyes: — Pupil irregular or eccentric, congenial ptosis, epican- 
thus, oblique Mongolian, palperbral fissure small, asymmetry, in 
size, in color strabismus. 

Ears: — Very large, very small. Darwinian tubercle, abnormal 
development, asymmetrical position or formation. 

Tongue: — Very large, very small, thick. Hat, pointed, fissured, 
enlarged papillae. 

Thyroid: — Enlarged, atrophied, absent. 

Thorax: — Breasts absent, atrophied, small, large, supernu- 
merary; development of breasts in male; pigeon breast, funnel 
breast. 



24 A GUIDE FOR THE CLINICAL 

Upper Limbs : — Very long, very short, asymmetrical; mal- 
formation of right, left hand; Angers united, supernumerary, two- 
jointed, very long, very short. Little, Angers imperfect. Left 
handed, ambidextrous. 

Lower Limbs : — Club foot ; toes united, supernumerary ; knock- 
knee, bow-legs, legs or feet very long, very short, asymmetrical. 

Genitals: — Incomplete descent of one or both testicles. 
Organs over-developed, undeveloped; atrophied. Hermaphrodism, 
true or false. Phimosis. Stenosis or reduplication of vaginal and 
uterine canals. Undeveloped uterus, ovaries, vagina. Clitoris 
enlarged or hooded. 

Skin:— Pallid, sallow, leathery, prematurely wrinkled, birth- 
marks. 

Hair :^Coarse, scanty on face, eye brows, chest, pubes. Hairy 
moles or tufts on body. Gray hair in patches. Bald spots. Eye 
brows meet. Abnormal distribution of hair. 

Nails: — Thin and friable, pigmented, arched and thickened, 
long, short, furrowed lengthwise, crosswise. 

Bodily characteristics : — Gigantism, dwarAsm. General 
balance relaxed. Asymmetrical posture or head balance. Scoliosis, 
Lordosis. Feminine aspect. Mincing or shuffling gait. 

11. 

General Appearance as Regards Past and Present 
Health. 

General state of nutrition. Color of mucous membranes. 
Presence of jaundice, oedema, etc. Presence of skin eruptions 
(describe in detail and chart). Evidences of syphilis recent or 
remote, (gummata, scars on genitalia, tibial crests, and tongue). 
Evidences of old rickets. Signs of gout or rheumatism. Enlarge- 
ment of thyroid. Scars and bruises. Bodily temperature. Appar- 
ent age. 

III. 

Spontaneous Complaints. 

Feeling sick, weakness, nervousness, vertigo, headache, pain, 
etc. These should all be carefully investigated and recorded in the 
patient's ov^^n words, or if he does not speak, with his description. 



EXAMINATION OF CHILDREN 25. 

IV. 
Respiratory System. 

A. Upper Respiratory Tract. 

Character of naso-pharyngeal mucous membrane, presence of 
obstructions such as polypi, adenoid growths, or enlarged tonsils. 
Abnormalities of pharynx or larynx. 

B. Lower Respiratory Tract. 

Rapidity and character of breathing (easy or difficult, nasal or 
oral, abdominal or thoracic). Dyspnoea. Any pain on breathing, 
cough or expectorations (character and amount). Shape and 
degree of expansion of chest. Inspection, palpation, percussion, 
and auscultation (make both anterior and posterior examination of 
chest including apical region). 

V. 

Circulatory System. 

Sensation of palpitation, arhythmia, pain or anxiety, with full 
details. Position and character of cardiac impulse. Occurrence of 
abnormal pulsation in chest wall. Area of cardiacdullness. Char- 
acter of sounds at apex and base. Pulse: Rate, quality, variations 
in both as the result of change posture (lying, sitting, standing), 
emotion and exertion. Sphygmogram. Sphygmomanometricread- 
ing. Condition of the walls of the arteries (radial, brachial, tempor- 
al, femoral, dorsalis pedis, and in ocular fundus on both sides) 
Abnormalities of veins — -variecosities, pulsations, etc. Examina- 
tion of blood. 

VI. 

Digestive System and Abdomen. 

Appetite, thirst, nausea, vomiting, eructation, pain, etc. Con- 
dition of mouth, teeth and tongue. Size and position of stomach. 
Analysis of stomach contents where indicated. Outline of liver, 
spleen, palpation of kidneys, (movable or not movable^ Charac- 
ter and frequency of stools with microscopic examination if indi- 
cated. Areas of tenderness over abdomen (McBurney's point, etc.) 



26 A GUIDE FOR THE CLINICAL 

VII. 

Urinary Apparatus. 

Pains or subjective symptoms referred to kidneys or bladder. 
Frequency of micturition. Amount of urine in 24 hours. Chemi- 
cal and microscopicexaminationof urine. Inflammationof mucosa, 
bladder and urethra. 

VIII. 

Genital Organs. 

The menstrual functions, their regularity as to frequency and 
amount; any accompanying symptons (pains, irritability, nervous- 
ness, etc.) Examination of the pelvis per vaginam orper rectum as 
indicated. Quantity and character of any discharge. 

Frequency and character of functional activity. Examination 
of prostrate if indicated. Presence of scars or discharge. 

XI. 

Nervous System. 



A. Centripetal Apparatus. 
I. Special Senses. 

Smell. Examination of nerves. Test each nostril separately 
with peppermint, oil of cloves, and asafoetida. Note the actual 
answers. 

Vision. Examine cornea (for opacities and signs of intersti- 
tial keratitis), lens, humors, and ocular fundus (describe and chart 
any abnormalities). Acuity of vision (any areas of refraction to 
be corrected). Fields of vision (examine with fmger roughly and 
if necessary with perimeter for scotomata, hemianopia, etc. 

Taste. Condition of tongue should be noticed. Test separately 
the interior two-thirds and posterior third on both sides with salt, 
s.ugar, quinine and vinegar. (Do not a-llow the patient to roll the 
tongue in the mouth and let him answer by pointing to card on 
which is written salt, sweet, bitter, sour). 



EXAMINATION OF CHILDREN 27 

Hearing. Examine the meatus, canal, and membrane. Note 
the presence of any cerumen or discharge. Test each ear with the 
watch and tuning fork both for air and bone conduction. Galton's 
whistle. 

2. Cutaneous Sensibility. 

Both touch and pain sense should be examined roughly in 
every case and a more exhaustive examination with charts made 
wherevnr any changes are noted. Always test the ulnar borders of 
the fore-arm, the outer sides of the thighs just abovetheknees, and 
the dorsum and soles of the feet. Remember sensibility to pain and 
temperature may be diminished or lost when the tactual sense is 
unaffected in tabes, general paralysis, etc., as well as insyringomelia. 

1. Subject symptoms. — Pain, (character and distribution), 
numbness, formication, pins and needles, coldness, and heat. 

2. Tactile sensibility. — Examine with tip of finger or by draw- 
ing thread over the skin. Note the acuteness of sensibility and the 
accuracy of localization for space andtime. In recording on a chart, 
tactile anaesthesia is marked by horizontal lines and its degree in- 
dicated by the length of the lines. 

3. Pain.— Test with a pin point, which should be guarded by 
the tip of the examiner's finger to prevent discrimination as point 
by the smallness of the area touched. Ask whether the stimulus 
is actually painful, and note accuracy of localization in lime and 
space. Be sure that patient is attending. Mark on chart with ver- 
tical lines. 

4. Temperature. — Test with warm and cool water in test-tubes. 
For charting use diagonal lines. 

5. Stereognostic sensibility. — Tliis is not strictly a pure cuta- 
neous sensibility, but may for convenience be considered here. It 
consists in the power to recognize objects by palpation with the 
eyes closed. 

3. Deep Sensibility. 

1. Tendernessof nerve trunks to pressure. (Ulnar at elbow and 
musculo-cutaneous of leg below head of fibula, i 

2. Tenderness of muscles on pressure. 

3. Sense of position. Test by asking patient to describe the 
position of a limb after it has been passively moved or by asking 
him to imitate the position with the limb on the other side. 

4. Sense of passive movement. 

5. Sense of tension as estimated by judging weights. 



28 A GUIDE FOR THE CLINICAL 

6. Coordination of muscles. Finger-nose test, Rhomberg test, 
walking along line, putting heel on opposite knee, etc. 

7. Pallaesthesia. — Sensibility to vibration of tuning fork. 

B. Centrifugal Apparatus. 



Cranial. 

i. -Ocular Group Pupils: — Size, shape, position, (central or 
eccentric) . Note any evidence of old iritis. Rapidity and degree of 
contraction to light (notice whether they dilate again at once and 
oscillate) , dilatation to shade. Contraction in accommodation, con- 
vergence, and after tightly closing the lids. Dilation from painful 
stimulus, e. g., over cheek bone. Where there is any suggestion of 
affection of the sympathetic test dilatation with cocaine. 

Extrinsic muscles : -—Are the optic axes parallel? Examine 
movements of the eyes in all directions and note whether the move- 
ment is full and steady (jerky, nystagmoid, nystagmus. In this last 
describe the direction of the movement and the position of eyes in 
which it occurs.,; If there is any complaint of diplopiaexamine with 
flame and colored glass. 

Upper lids: — Width and equality of palpebral Assures the di- 
rection of the wrinkles on the forehead (may be altered as result of 
weakness of the levator palpebrae.) Ptosis, subptosis. Lagophthal- 
mos, von Graefe's and Stellwag's signs. 

2. Masticatory Group: — Any deviation of the jaw in opening 
the mouth, power to hold jaw open, power in closing (compare the 
degree of hardening of the masseters and temporals in clenching 
the teeth). 

3. Facial Group. Upper Part — Scowling, frowning, and rais- 
ing the eyebrows, closing the eyes tightly. 

Lower Part — Showing the teeth and tongue, whistling. Com- 
pare the two naso-labial folds. Observe the facial movements also 
in emotional and associated movements (clenching flsts,etc.) 

4. Phonation-Articulation-Deglutition. Character of voice 
smooth or harsh, nasal. (For this last good test words are 
amber, under, kick, cook^ . If there is any change examine the 
larynx. Movements of the palate in phonation (compare the 
arch on each side of the uvula.) Hardening of the muscles of the 
floor of the mouth when the tongue is pushed against the closed 
teeth. Position of the tongue as it lies in the mouth when this is 
slowlyopened. Protrusion of tongue (use line between median 



EXAMINATION OT CHINICAL 29 

incisor teeth as guide for midline), freedom of movement when 
out, power of thrust into either cheeli. I^ook for signs of 
early atrophj' of the tongue along the lateral margins. De- 
scribe any defects in articulation, using as test words elec- 
tricity, truly rural, royal Irish constabulary, Methodist Epis- 
copal, particular popularity. If there is any difficulty in 
swallowing, note whether due to defect in palate (nasal voice 
and regurgitation of fluids), in passing the bolus back to the 
pharynx, or below the pharynx. If indicated use oesophageal 
sounds. (Exclude thoracic aneurism first.) 

Spinal. 

1. General muscular development in relation to occupa- 
tion, tonus of muscles, power in comparison with development. 
Always compare on the two sides the grip (use dynamometer), 
flexion and extensioa at the wrist, elbow, knee, and ankle. 
Describe the general character of the movements as to ease or 
clumsiness, extent (if restricted examine the joints^, and take 
special note of gait (when not conscious of direct examination; , 
taking off and putting on clothes, and writing. Samples of the 
last should be inserted in every case — name, date, and test 
phrase. Where any weakness or atrophy is observed, it is 
necessary to examine in detail the muscles moving each point, 
and often to examine the excitability of the muscles to mechan- 
ical stimulation and to the electric current — ^Faradic and Gal- 
vanic. 

2. Abnormal Contractions. a. — Fibrillary twitching, ils 
distribution and persistence, and conditions modifying its oc- 
curence, b. — Tremors. Location, character, rapidity, am- 
plitude, and direction. How modified by rest, exercise, sleep, 
and effort of will. c. Irregular movements, such as chorea" 
d. ■ Spasm, such as facial spasm, hysterical spasm, e. Psycho- 
genic — tic, catalepsy, negativism, etc. 

3. Examination of cerebral spinal fiuid. 



30 A GUIDE FOR THE CLINICAL 

C. Reflexes. 
I. Superficial. 

Corneal. Blow on cornea. 

Palatal, 

Sneezing. 

Scapular, Gluteal. 

Epigastric, Abdominal. Cremasteric. 

Plantar. Stimulate with the finger or handle of percus- 
sion hammer, drawing it from heel toward the toes. Be care- 
ful to have the knee bent and the ankle loose, and do not press 
hard on the sole. Describe the movements which occur, espec- 
ially in the big toe, and where no response is obtained in the 
toes, notice for any contraction in the Tensor Fasciae Femoris. 
Note whether response is more readily obtained from the inner or 
outer side of the sole of the foot. 

2. Deep. 

Masseteric. Tap on the chin with the mouth slightly open. 

Scapulo-humeral. Tap on the edge of the scapula just above 
the ridge while the arm hangs loosely by the side. 

Biceps. Percuss the thumb placed on the tendon. 

Supinator longus. Tap the lower end of the radius. 

Triceps. Tap the tendon. 

Knee jerk. Examine with feet resting on the floor, but pushed 
forward as far as possible. Compare the two sides and note the 
ease with which obtained, whether elicited with every tap, the 
effects of reinforcement. Depressed patellar jerk when lying down. 
Note the occurrence of patellar clonus, and spread to other muscles. 

Adductor jerk by tapping the inner side of the knee. 

Ankle jerk. Examine where possible with the patientkneeling 
with feet hanging over the edge of the support and tap the tendon, 
varying the tension of the muscles by bending the ankle more or 
less. (This reflex is often lost earlier than the knee jerk.) In ex- 
amining for ankle clonus, have the patient lying down, and test 
with the knee flexed at various angles. 

Gordons paradoxical reflex. Pressure on the calf ^flexor) 
muscles gives rise to extension of the big toe. This is probably 
present in slighter degrees in pyramidal tract affection than the 
Babinski phenomenon. 



EXAMINATION OF CHILDREN 31 

3. Organic. 

Bladder. Delay; retention; incontinence witli full or empty 
bladder; dribbling after micturition; residual urine. Consciousness 
of passage of urine. Peculiar sensations. 

Reef urn. Spasm or relaxation of sphincter (insert finger), in- 
voluntary evacuations, consciously or not. 

Sexual. Any abnormalities. 

Examination of Convulsions. 

Is there any aura? Describe carefully -in patient's own words. 
Is it always present? Does it sometimes occur without a convul- 
sion? Is consciousness lost? How soon? And for how long? Is 
there a cry? fall? Where does the convulsion begin? Always in 
the same place? What is the direction of its march? Is it confined 
to a single part?- to one side of the body? general? Is a paralyzed 
part involved or omitted? Is there a clonic as well as a tonic stage? 
Attitude of the body at the height of the convulsion? What is the 
average duration? Frequency and hour of occurence? Is the 
tongue bitten? Involuntary micturition or defaecation? Where 
possible, study carefully the condition of respiration and circula- 
tion, the pupils andreflexes during and after the convulsions. Is it 
followed by deep sleep? headache? transient or permanent weak- 
ness or paralysis of any part of the body? any automatic move- 
ments? Investigate for any history of petit mal (momentary sen- 
sations, flashes of light, vertigo, loss of self, involuntarymicturi- 
tion, etc.) for any evidence of automatism, sudden inexplicable 
outbursts of anger, etc. Any conditions which seem to have any 
bearing in the excitation of the convulsions. 



32 A GUIDE FOR THE CLINICAL 



Record to be Made at Post-Mortem 
Examination. 

Name Case No Date 

Age Sex Color Address Married — 

Single ....Admitted Died Autopsy Hrs. 

after death, weather cold, mild, hot. 

History alcohol syphilis Tbc Injury Clinical 

diag Autopsy ordered by Performed by 

Cause of death 

1. External Appearances 

Nutrition Weight Lbs., l^ength 

Appearance of skin , Eruptions Scars 

Wounds — Bruises — 

Deformities P. M. Lividity : . . 

2. Read 

Scalp Hair Eyes, Sunken Protruding 

Pupils 

Skull depressions Size Thickness 

Injuries 

Fluid in Cranium Character 

Dura Mater, thickness Color 

Adherent to — 

Sinuses, quality of blood 

Thrombi 

Pia Mater, thickness 

Vascularity Fluid 

Vessels at base - 

Cortex 

Convolutions 

Brain, weight. . Consistency Color 

Ventricles lateral size Contents 

Choroid Plexus Softening 

Blood Clots Tumors . . 

3. Spine, 

Deformities Cord 



EXAMINATION OF CHILDREN 33 

Thorax and Neck. 

Glands Neck Axillae Mammae 

Tongue Salivary glands Tonsils 

Trachea Larynx Mediastinal gland 

Lungs left upper Lobe : 

Lungs left lower Lobe 

Lungs right upper Lobe 

Lungs right middle Lobe 

Lungs right lower Lobe 

Bronchi Diaphragm right side Left side 

Pleurae left adhesions : 

Effusion 

Right adhesions 

Effusion 

Heart 

Size Position 

Pericardium adhesions...- Effusion Quan Char, 

Thickness Surface 

Heart opened in situ blood Clotted 

Clots right Chicken fat Red White 

Clots left Chicken fat Red White 

Weight Ounces 

Hypertrophy R.V R.A. L.V L.A 

Dilatation R.V R.A L.V. L.A 

Cardiac Muscle Firm Friable Fatty Color . . . 

Valves Mitral Aprtic Tricuspid Pul 

Coronary Arteries Sclerosed Thrombosis 

Pulmonary Arterj^ 

Aorta Arch Thoracic Abdominal Others 

Genito Urinary Tract. 

Kidney Lft. wt. Oz. Color Shape Size.. 

Capsule Venae Stellae — Infarcts 

Cortex Relation to Medulla Cysts 

Pelvis Distended Fluid Pus Stone 

' Large White Kidney Passive Congest. Kidney 

Amount of perinephritic Fat — Movable Ide. . .2de. . .3de. . . 

Chronic contracted Kidney 

Right wt Oz., Color Shape Size 

Capsule Venae Stellae Infarcts 

Cortex Relation to Medulla Cysts 

Pelvis Distended Fluid Pus — Stone 

Lesion Pas. Cong LargeW Ch. Cont 

Amount of perinephritic fat. . .Movability ide. .2de. ..3de. . . 
Supra Renal Bodies Lft Rt 



34 A GUIDE FOR THE CLINICAL 

Bladder contents Oz Thickness M. M. 

Ureters Lft Rt 

Prostate Size Cent. Lobe Rt Lt... 

Urethra M.M Stricture Malfor 

Testicles Lft Rt 

Seminal Vesicles Lft Rt 

Uterus Size Tumor M.M 

Tubes Lft..... Rt. 

Ovaries Lft Rt 

6. Abdomen. 

Position of organs • . 

Peritoneum Adhesions 

Fluid in cavity Amt Character 

liiver Weight Color Size Surface... 

Edges Cut Surface 

Consistence 

Gall Bladder Stones 

Gall Ducts Bile 

Lesion 

Pancreas 

Spleen Wt. Capsule Cut Surface — 

Peritoneal Lymph Glands 

Stomach size Contents 

Mucous M. 

Thickness Ulcers Scars 

Pylorus thickness Esophagus 

Congestion Lesion •. 

Small Intes. Appendix contents 

Ulceration Contents 

Obstruction Intuss Volvulus. 

Parasites Hernia 

Large Intest dysentery Contents 

Construction 

Location • 

Hemorrhoids » 

Other organs 

Spec. Preserved in Museum No 



EXAMINATION OF CHILDREN 35 

Mental Examination. 
I. 

Examination for Mental Diagnosis. 

BINET=SIMON MEASURING SCALE OF THE IN = 
TELLIQENCE. 1911 REVISION. 

Idiots. 

Mental Age i and 2 Years. 

1. Move lighted match slowly before child's eyes. Full credit 
given if eyes folloio light for briefest period. 

2. Place a wooden block in child's hand. Credit given if block 
is grasped. 

3. Show the wooden block without touching child with it and 
say, "This is for you, don't you want it to play with?" Credit 
given if child takes it. 

4. Offer child a piece of wood and a piece of chocolate of the 
same size. Credit given if he eats the chocolate and does not at- 
tempt to eat the ivood. 

5. Show child a piece of chocolate, then wrap it in paper and 
present it to him, telling him to eat it. Credit given if he removes 
the paper before eating. 

6. Make simple movements, clapping the hands, sitting down, 
standing up, etc., and tell child to do the same. Credit given if one 
imitation is accomplished. 

Imbeciles. 
Mental Age 3 Years. 

7. Show me your nose. Show me your eyes. Show me your 
mouth, 

8. Listen well and repeat what I say. 4; 3 — 7; 6 — 4; 5 — 8; 
Pronounce numbers slowly and distinctly with one-half second in- 
terval between, one pair at a time. Full credit given for one exact 
repetition. 

9. Place Picture 1 before child and ask, "What is that?" or 
"What do you see there?" Follow this by Pictures 2 and 3. (Fig- 
ures 1, 2, 3.) Full credit given if some objects are enumerated. 



36 A GUIDE FOR THE CLINICAL 

10. "What is your name?" If first name only is given — '"and 
your other name?" 

Surname required. 

11. "Listen well and repeat what I say. I am cold and hun- 
gry." No errors of any kind alloived. 

Mental Age 4 Years. 

12. "Are you a little boy or a little girl?" If necessary— "Are 
you a little girl?" "Are you a little boy?" 

13. Show child a pen knife saying; "What is that? What is 
it called?" Then show' penny and finally key, asking same ques- 
tions. Name of three objects required. 

14. "Listen well and repeat what I say. 4 — 9 — 2; 3 — 7 — 4; 
5 — 8 — 1." Full credit given for one exact repetition. 

15. "You see these two lines. Tell me which is the longer." 
(Figure A.) 

Mental Age 5 Years. 

16. Place two boxes weighing 3 and 12 grams respectively on 
the table before the child leaving a space of 5 or 8 centimeters be- 
tween them and say, "You see these two boxes? Tell me which is 
the heavier." Repeat, using boxes weighing 6 and 15 grams and 
repeat again using first pair. 

//' there is still doubt about the child's ability to compare 
weifihts, repeat process. 

17. Draw a square 3 to 4 centimeters in diameter with ink 
and ask the child to copy it, giving him pen and ink to do so. 

18. "Listen well and repeat what I say. My name is Charley. 
0! the naughty dog." 

19. Place four pennies in a row before the child and say, "Do 
you see these pennies? Count them and tell me how many there 
are." ■ 

Child is required to point to each with finger, no error allowed. 

20. Place an oblong card on the table before the child and 
place also, nearer to the child 2 triangular cards formed by cutting 
another card like the first one in two, along a diagonal. Place 
these two triangular cards in such position that their hypotheni 
form a right angle one with the other, then say to the child, "Put 
these two pieces together so that they will form one card like this," 
(indicating the oblong card.) If the child turns over one triangu- 
lar piece without noticing it it is permissible to begin again. 




FlfiURE 3. 



Figure A. 




Figure 4. 



EXAMINATION OF CHILDREN 47 

Mental Age 6 Years. 

21. "Is it morning now?" "Is it afternoon now?" 

22. "What is a fork?" "What is a table?" "What is a chair?" 
"What is a horse?" "What is a mama?" 

//' some use of three of the objects is mentioned the reponse is 
considered correct. 

23. Draw a diamond figure with ink and ask the child to copy 
it, giving him pen and ink for the purpose. 

2i. Place 13 pennies in a row on the table before the child 
and say, "Count these pennies for me, pointing to each one as you 
count it." 

25. Show pictures of faces (.Figure 4). Expose first the up- 
per two alone, next the two middle ones, and last the two lower 
ones, saying each time, "Which is the prettier of these two faces? ' 
No error allowed. 

Mental Age 7 Years. 

26. "Show me your right hand." "Show me your left ear." 
No error alloived. 

27. Show picture as in Test 9, requiring descriptions. 

28. "Take this key and put it on that chair, bring me that 
book lying on the table, and open the door." Repeat these direc- 
tions distinctly ttvice. 

29. Place three two cent and three one cent stamps on the 
table before the child. Make sure that he knows the 2's from the 
I's and ask him to count how much they would all cost. 

30. Have four pieces of colored paper, red, blue, yellow, and 
green. Point to "each asking "What is this color?" No error 
allowed. 

Mental Age 8 Years. 

31. (a) "Do you know what paper is?" "Do you know what 
cardboard is?" "Are they alike?" "In what way are they not 
alike?" 

(b) "Have you ever seen a lly?" "Have you ever seen a but- 
terfly?" "Are they alike?" "In what way are they not alike?" 

(c) "Do you know wood when you see it?" "Do you know 
glass when you see it?" "Are they alike?" "In what way are they 
not alike?" Two satisfactory answers required. 



48 A GUIDE FOR THE CLINICAL 

32. "I want you to count backward from 20 to 0. Like this — 
20 — 19 — 18/' This must be accomplished in 20 seconds. One error 
allowed. 

33. The four pictures in figure 5 are shown one at a time and 
the question asked with each, "What is missing in this picture?" 
Three correct replies required. 

34. "What day is today? What date is it?" 

35. "Listen well and repeat what I say : 3-8-5-7-1; 9-2-7- 
3-6; and 5-1-8-3-9." One group given at a time. One exact 
response required. 

Mental Age 9 Years. 

36. In a pile before the child place the following coins; — ten 
pennies, two nickels, two dimes, one quarter, one half dollar. 
Then propose a game of storekeeping, the child to keep the store 
and use the pile of money to make change, the experimenter to be 
the customer. Add some articles for sale., Then buy something 
for four cents. Give the child a quarter and require the change. 

37. Test No. 22. Definitions superior to use are required. 

38. Show the child successively a penny, a dime, a dollar, a 
quarter, a nickel, a half dollar, a two dollar bill, a ten dollar bill, 
a five dollar bill. Ask, "What is this?" with each. 

39. Name the months of the year in order. One error allowed, 
time 15 seconds. 

40. (a) "If you were going away and missed your train, 
what would you do?" 

(b) "If one of the boys should hit you without meaning 
to, what would you do about it?" 

(c) "If you broke something belonging to some, one) else, 
what would you do about it?" Txvo good responses required. 




FlCURE 5. 



EXAMINATION OF CHILDREN 



51 



Mental Age lo Years. 

41. Place on the table before the child five boxes weighing 3, 
6, 9, 12 and 15 grams respectively. Say to him "Theselittle boxes 
all weigh different amounts. Some are heavier and some lighter. 
I want you to place the heaviest here and by its side the one 
which is a little less heavy, and then the one a little less heavy and 
the one still a little less heavy, and Anally here the lightest." Three 
trials made, the boxes mixed after each. Two successes in three are 
required. 




-tm- 



Figure 6. 



42. "I am going to show you two drawings and after you have 
looked at them I shall take them away and ask you to draw them 
from memory. You must look at them closely because you will only 
have them for ten seconds and this is a very short time.' (Draw- 
ings shown in figure 6.) 

Full credit is given if the whole of one drawing and half of the 

other is reproduced exactly. 

43. "I am going to read you some sentences; in each one of 
them there is something foolish or absurd. You listen carefully 
and tell me each time what it is that is foolish." 

(a) "An unlucky bicycle rider fell on his head and was in- 
stantly killed; they took him to the hospital and fear that he can- 
not get well." — After a pause — "What is foolish in that?" 

(b) "I have three brothers, Paul Ernest, and myself" — "What 
is foolish in that?" 

(ci "The body of a young girl cut into 18 pieces was found 
yesterday. People think that she killed herself". — "What is fool- 
ish in that?" 

(d) "There was a railroad accident yesterday, butnot a serious 
one, only 48 persons were killed" — "What is foolish in that?" 



52 A GUIDE I^OR THE CLINICAL 

(e) "A man said; — "If I should ever grow desperate and kill 
myself I should not use Friday for the purpose because Friday is an 
unlucky day and might bring me unhappiness" — "What is foolish in 
that?" 

Correct solution of three of the five statements required. 

44. (a) "If you were delayed on your way to school, what 
would you do about it?" 

(b) "Before taking part in something very important, what 
would you do?" 

(C) "Why do we more easily pardon a bad act done in anger 
than a bad act done without anger?" 

(d) "If some one should ask your opinion of one whom you 
did not know very well, what would you say?" 

(e) "Why should we judge a person by his acts rather than by 
his words?" 

Two errors allowed.. 

45. Write the words, Paris, fortunes, stream. Show them to 
the child reading then! to him several times. Then give him pen 
and ink and tell him to write a sentence containing all three of these 
words. 

Full credit is given for two sentences containing the three words. 
Mental Age 12 Years 

46. "Which is the longer of these two lines?" Fig. 7. 
"Which is the longer of these two lines?" Fig. 8. 
"Which is the longer of these two lines?" Fig. 9. 
"And of these?" Fig. 10. 

"And of these?" Fig. H. 
"And of these?" Fig 12. 

Full credit given if suggestion of longer line to the right does 
not hold in last three pair. One -half credit if it only partially holds. 

47. TQ°,i^^. Credit given for one sentence containing the 3 words. 

48. "I want you to say just as many words as you can in three 
minutes. Some boys say as many as two hundred. Now you must 
try and see how many you can think of." 

Sixty words the minimum accepted. 

49. "What does charity mean?" "What does justice mean?" 
What does kindness mean?" Two correct answers required. 

50. "Find the sentences which these words make. Fix the 
words in their proper order." 



c 

s 



EXAMINATION OF CHILDREN 65 

(a; At-counti'y-we-for-started-hoiir-an-the-early. 

(b) Teacher-I-to-my-exercise-asked-my-correct. 

(c) Defends- a-his-dog-master-good-bravely. 

Mental Age 15 Years. 

51. "I am going to say seven numbers. Listen well and repeat 
them exactly. 4-9-2-6-5-3-7; 9-3-5-1-8-2-6: 2-7-4-9-3-8-5." 
One success in three re<iuireil. 

52. "Do you know what the word rhyme means? Two words 
that rhyme are two words which end in the same sound. Thus 
Sinriing rhymes with Ringing. Sing-ino, Ring-infj. They both end 
in ing. The same way Sailor rhymes with Tailor. Sail-or and 
Tail-or. They both end in or. Do you understand? Now lam go- 
ing to give you a word and you try to And the words which rhyme 
with it. The word is obey. Find all the words that rhyme with 
obey." 

Three words required in one minute. 

53. "Listen carefully and repeat exactly what I say, Theother 
day I saw on the street, a pretty yellow dog. Little Morris has soiled 
his nice new apron." 

54. Test No. 9 and 27. Interpretation required. 

55. (a) "A woman was walking through a park in Chicago. 
Suddenly she stopped dreadfully frightened. She ran to the nearest 
policeman and told him she had seen hanging to the limb of a tree 
a" — after a pause, — "A what?" 

(bj "My neighbor has just received some singular visits; one 
after another, a doctor, a lawyer, and a priest called. What is 
happening at my neighbor's? 

Full credit given only if both problems are answered satisfac- 
torily. 

Adult. 

56. "Here is a paper folded in four, suppose that here -point- 
ing to a small triangle which has been drawn in the middle of that 
edge which consists of but a single fold), I cut out this little triangle 
of paper. Now if I unfolded the paper how would it look? Draw 
the paper as it would appear if unfolded and show how and where 
it would be cut." (Figure 13.) 

Requirement : Tiro diamonds drawn in line with each her and 
each in the center of one half of a square. 

57. An oblong card cut in two along a diagonal is placed in 



66 A GUIDE FOR THE GLINrCAT- 

position before the subject. "Look well at the lower piece of card. 
Suppose that I lift it and place this edge (tracing the edge a-c with 
the finger) on this edge fa-d of the upper piece.) Suppose further 
that this point (c) is placed just on this point, (b).. Now I take 
away the piece, in your imagination, pi ace it as I have described and 
draw its outline in this position. Commence by following the out- 
line of the first piece." (Figure 14.) 

It is required that a right angle be represented at (b) and that 
the edge a-c be shorter than the edge a-b. 

58. "What is the difference between laziness and idleness?" 
"What is the difference between event and advent?" "What is the 
difference between evolution and revolution?" Two correct re- 
sponses required. 

59. "There are three principal differences between a King and 
a President of a Republic. What are they?" 

Required answer: Royalty is hereditary, the tenure of office is 
for life and it's powers are very great; the president is elected, his 
tenure of office is limited and his powers are less extensive. 

60. "Listen attentively to what I am about to read. After 
finishing I shall ask you to repeat the sense of the selection: 
Many different opinions are given of the value of life, some deem it 
good, others bad. It would be more just to say that it is mediocre; 
because on the one hand our happiness is less than we would have 
it and on the other hand our unhappiness is less than others tvish 
for us. It is this medicority of life tvhich makes it just or rather 
which prevents it from being radically unjust." 

It is required that the thought of this selection be understood. 




Fir,iJRE 31. 




Fun IRE 1 i. 



EXAMINATION OF CHILDREN 



69 



II. 



Tests For Mental Analysis. 



Part I. Sensation and Perception. 



TESTS. 



MATERIALS 
REQUIRED. 



DIRECTIONS FOR TESTING. 



1. VISUAL 

a. Acuity. 



E Test card (F. A. 

Hardy, Chicago.) 
Trial frame for 

lenses. 
One-. 75 D. &one + 

.75 D. lens. 
One blank disc. 



Place subject 6 meters in 
frontoftestcard, which should 
be hung on a well illuminated 
wall and on a level with the 
S's eyes. Tell subject that 
whenever you point to an E 
he is to show in which direc- 
tion the prongspoint by point- 
ing in the same direction. 
Put trial frame onS., adjust 
nose piece and place blank disc 
before lefteye. Point to sev- 
eral E's inline No. 7. If these 
are correctly seen the vision 
is normal and is recorded R. 
E.I. If theyarenotseenclear- 
ly. point to larger E's on lines 
6 tol recording vision as 8-10 
6-10, 4-10, 3-10, 2-10,orl-10 
as indicated on card. If none 
of the E's can be clearly seen 
the eye is practically blind 
and its vision is recorded as — . 
Now placa the +• 75 D. lens 
before the right eye. If this 
blurs the visiontheeye isem- 
metropic. If it enables S. to 
see smaller typethe eye is 
hyperopic. To the first re- 
cord should be added the de- 
gree of acuity with this lens 
i. e. V. R. E.=6-i0+Hy8-10. 
If vision is less than 1 and the 
+. 75 D. lens blurs it, remove 
the lens, and substitute the 



70 



A GUIDE FOR THE CLINICAL 



TESTS. 



MATERIALS 
REQUIRED. 



DIRECTIONS FOR TESTING. 



b. Binocular 
Vision. 



Trial frame Mad- 
dox Rod, blank disc 
and candle. 



-.75 D. lens. If thesubjectcan 
now see smaller type, the eye 
is myopic and a record of its 
acuity with this lens should 
be added i. e. V. R. E=6-10+ 
My 8-10. Remove lens, point 
to radiating lines at head of 
test card and ask S. which line 
looks the blackest. Have him 
tilt head and ask him whether 
the same line still looks the 
blackest. If it does not astig- 
matism exists and this fact 
should be added to the record. 
V. R. E. 6-10+My 8-10+As. 
Repeat tests using left eye. 
(Adapted from Whipple.) 

Place lighted candle 6 me- 
ters from S. and on a level with 
his eyes. Adjust trial frame to 
center lens. Place blank disc 
before left eye and Maddox 
Rod with bar in horizontal 
direction before right eye. S. 
should see a long narrow ver- 
tical streak of red light. Re- 
move blank disc and tell S. to 
state at once whether the 
streak seems to pass through 
the candle flame. If it does 
there is no heterophoria. If 
it is seen to the right of the 
flame esophoria exists and if 
to the left exophoria. Now 
turn the rod until bars run 
vertically. The streak should 
now appear in a horizontal 
direction. Remove disc and 
streak should be seen as pass- 
ing through the flame. If it 
is seen below the flame right 
hyperphoria exists, if it is 
Seen above, left hyperphoria. 



EXAMINATION OF CHILDREN 



71 



TESTS 



JvfATEEIALS 
REQUIRED 



DIRECTIONS FOR TESTINC4 



c. Fields of 
vision and of 
color vision. 



d. Color vis- 
ion. 

e. Visual per- 
ception span. 



Perimeter. 



Holmgren's Wool 
Test. 

Nine cards, on each of 
which are a different 
number of vertical 
lines, 2, 3, 4, 5, 6, 7, 
8, 9 and 10 respect- 
ively. 

The lines are 5 cms 
long and 1 cm. apart. 
Nine cards on each 
of which appears a 
different number of 
groups of two ver- 
tical lines each 2, ',), 



Repeat process using left 
eye. (Adapted from Whip- 
ple.) 

Cover left eye of S. and 
place him before perimeter 
in position to focus with 
right eye on the little mir- 
ror. Place arc of perimeter 
i'n horizontal position. 
Gradually move the small 
white disc from the extreme 
right of the arc toward the 
center and record degree 
marked on arc when disc is 
first seen by S. Repeat pro- 
cess bringing disc toward 
the center from the left, 
from above, from below and 
also on the diagonal merid- 
ians.. Repeat process with 
the yellow, blue, red and 
green discs. Using record- 
ed distances, plot a chart of 
the visual fields for white 
and for each color. Repeat 
tests using left eye. 

Directions accompanying 
test material. 

Expose cards of two 
series, one at a time, in ir- 
regular order, not long 
enough for subject to count 
lines, and record the num- 
ber of lines he thinks he 
sees and the actual number. 



72 



A GUIDE FOR THE CLINICAL 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



2. AUDITORY 

a. acuity, 



b. Localiz- 
ation of sound, 



4, 5, 6, 7, 8, 9 and 10 
respectively. Lines 
5 cms. long. Spaces 
between lines in 
groups 5 mms. be- 
tween groups 1 cm. 

(1). The McGallie 
Audiometer. 



(2). The following 
list of words : high 
pitched — twenty, 
thirty, six, sixty, 
seven, sisters, Swiss, 
ice, fleece, sense, his- 
sing. 

Low pitched — Five, 
one hundred, Robert, 
brothers, organ, to- 
morrow, pump, doc- 
tor, wound, hound. 



Metal Snapper. 



This instrument is prac- 
tically a Politzer acoumet- 
er placed in a sound-proof 
box, through which the 
sound escapes by way of 
an opening the size of 
which may be varied, and 
is carried to either or both 
ears by rubber tubes. It 
can be used in a smaller 
room than the acoumeter 
and under noisier condi- 
tions. Directions accom- 
pany the instrument. 

Whisper Test. — The words 
should be heard when 
whispered at a distance of 6 
meters. S. should stand with 
one ear toward experiment- 
er and other ear plugged. 
Each ear should be tested 
separately. If S. is unable 
to hear whisper, use ordin- 
ary tone, flrst in low voice 
and then in loud if required. 
Inability to hear high pitch- 
ed words indicates nervous 
deafness. Inability to hear 
low pitched words indicates 
disease of conducting appa- 
ratus. 

Place S. in chair, blind- 
fold him. Make a sharp 
metallic noise with snapper 



EXAMINATION OF CHILDREN 



73 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



c. Range of 
tones discern- 
ible. 



Three. Tuning forks, 

—50, 200 and 500 
vibrations. 

Rubber topped ham- 
mer. 

Galton Whistle. 



d. Auditory 

perception 

span. 



Metal Snapper. 



3. TACTILE, 
a. Acuity. 



Jastrow's Improved 
Aesthesiometer. 



above head, bacli of head, 
front of head, and on either 
side. Each time sound is 
made ask S. where it is and 
record both correct position 
and S's answer. 

The fork of 50 vibratiions 
gives a tone of very low 
pitch, but one that should 
be heard by every normal 
ear. The tone one octave 
below this is of doubtful 
audability. The forks of 
200 and 500 vibrations gives 
tones in the middle register. 
The Galton Whistle gives 
the highest pitched tones 
discernible. 

Sound forks by striking 
one prong at about % dis- 
tance from the top a clear 
tap of moderate strength 
with the hammer. 

The directions for using 
the Galton Whistle accom- 
pany the instrument. 

Sound snapper 2, 3, 4, 5, 
6, 7, 8, 9 and 10 times. Also 
group sounds in 1, 2, 3, 4, 5, 
6, 7, 8, 9 and 10 groups of 
two sounds each, thus the 
group of nine will coatain 
18 sounds. Present these 
two series in irregular order 
and record the number of 
sounds made and the num- 
ber S. thinks he hears. 

Seat subject before a ta- 
ble, have him roll his 
sleeves up above the elbow 



74 



A GUIDE FOR THE CLINICAL 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



b. Localiza- 
tion of stimu- 
lus. 



Jastrow's Improved 
Aesthesiometer, 



and rest forearm on the ta- 
ble volar side uppermost. 
Show him the aesthesiome- 
ter and tell him you are go- 
ing to touch him sometimes 
with one point, and some- 
times with two, and that he 
is to pay strict attention and 
tell whether he is touched 
with one or two points. 
Screen arm from his view. 
Begin with points far apart, 
(90 mm. on scale), give a 
ready signal, then bring the 
points down simultaneously 
on the middle of the forearm 
parallelwith itslongitudinal 
axis. Let them rest there by 
their own weight for about 
two seconds, allowing the 
holder to slide one or two 
cm. down the stem of the 
instrument. 

Repeat the process, grad- 
ually decreasing the distance 
between the points and oc- 
casionally using one point 
as a check test, until a dis- 
tance is reached where sub- 
ject makes 8 correct judg- 
ments in 10. This is recorded 
as his limit for perception 
of two points on volar sur- 
face of arm. This may be 
repeated on different parts 
of the body if desired. 
(Adapted from Whipple.) 

Seat subject as for previ- 
ous tests, screen arm and 
touch with one point of 
the aesthesiometer various 



EXAMINATION OF CHILDREN 



75 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



c. Local iz- 
ationof direc- 
tion of moving 
stimulus. 



d. Sensitivity 
to tickling, 
4 Pressure 

a. Acuity. 

(1). Leastdis- 
cernible dif- 
ference. 



(2). Pain 
Threshold. 



Jastrow's Improved 
Aesthesiometer. 



Feather. 



Set of weights_ all of 
the same size and ma- 
terial, weighing 10, 11, 
12, 15, & 20 gms. re- 
spectively. 

Set of weights all of 
the same size and 
material weighing 100, 
101. 102, 105 and 110 
gms. respectively. 



GattellAlgometer. 



places on forearm, askings, 
to touch the same spot with 
the tip of finger. Record 
amount of error for each 
judgment and secure an av- 
erage of ten judgments. 

Seat subject as for pre- 
vious test, screen arm and 
draw point of aesthesiome- 
ter over arm from wrist to 
elbow, from elbow to wrist, 
from right to left and from 
left to right. Record S's 
judgments of the direction 
of moving touch stimulus. 

Tickle with feather and 
note muscular reaction. 

Use 10 gr. Aveight as a 
standard, the others in ser- 
ies as comparison weights. 
Place 10 gm. weights on S's 
out stretched palm. Let it 
remain there for two sec- 
onds. Remove it and place 
comparison weight in its 
place. Direct S. to say im- 
mediatly either heavy or 
light as his judgmentof sec- 
ond weight. Repeat process 
until the standard weight 
has been compared with the 
other four twice, once given 
as first weight of pair, once 
as last. Record judgments. 
Repeat process with second 
series of weights. 

Tell S. that you are going 
to press the palm of his 
hand and that he is to tell 
the first moment that it 



76 



A GUIDE FOR THE CLINICAL 



TESTS 



MATERIALS 
REQUIRED 



5. Thermal: 
a. Acuity. 
(1). Least 
discernible 
difierence. 



(2). Pain 
Threshold for 
heat. 



(5. KINAES- 
THETIC : 

Acuity. 



Thermaaesthesiome- 
ter. 



Thermaaesthesio- 
meter. 



Two series of 



DIRECTIONS FOR TESTLNG 



hurts him, that he is not to 
speak when it first feels 
uncomfortable, nor to wait 
until he can no longer bear 
the pain, but to tell at once 
when it begins to cause 
actual pain. Record press- 
ure indicated by scale. After 
the first pressure the pain 
limit will be lowered for 
that spot. , 

The instrument consists 
of two thermometers fast- 
ened together with electri- 
cial arrangements for chang- 
ing the temperature of one 
of them. This one is heat- 
ed until the difference in 
temperature of the two is 
about 10 degrees. Both are 
then placed on the volar 
surface of forearm and held 
there until the difference in 
temperature is impercepti- 
ble. The difference, in de- 
grees, of the temperatures 
of the two thermometers is 
then recorded as a. limin for 
discrimination of tempera- 
ture on the forearm. 

Increase temperature of 
thermometer until S. re- 
ports that it just causes 
pain. He must be directed 
not to speak when it merely 
feels uncomfortable, nor to 
wait until he can no longer 
bear it, but to tell the mo- 
ment he feels real pain. 

S. isdirectedtoliftweights 



EXAMLNATION OF CHILDREN 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



7. GUSTA- 
TORY: 

Acuity. 

8. OLFAC- 
TORY : 

Afuity. 



weights as described 
in tests for acuity of 
pressure. 



Salt, sugar, quinine, 
vinegar. 



Ammonia, assafoedita, 
tobacco, coffee, cheese, 
camphor, peppermint, 
turpentine. 



with thumb and first finger. 
A standard weight is placed 
on table directly in front of 
him, he lifts it and immedi- 
ately puts it down. It is at 
once replaced by another. 
He lifts this and says heavier 
or lighter as his judgment 
of the second weight. The 
process is then repeated un- 
til standard weight has been 
twice compared with the 
four others, once as first of 
pair, once as second. The 
order of presentation must 
be varied, i. e. standard 
must not be used as first of 
pair with all the weights 
and then as last with them 
all. 

Blindfold S., place a little 
of each on his tongue asking 
him to describe the taste as 
sweet, sour, salt or bitter. 

Let S. smell one at a time 
and name, if possible, if not 
describe odor. 



78 



A GUIDE B^OR THE CEINICAL 



Part 2. Reproductive Memory. 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



1. IMMEDI- 
ATE MEM- 
ORY SPAN 

a. Articulate 
sound combi- 
nations. 



Cag, mef, dit, nar, sos, 
guk, kim, pev, tab. 



b. Visual 
symbols for 

articula te 
sound combi- 
nations. 



c. Color. 



Gaf, zer, pux, rbo, dib, 
join, riw, yak, kem. 



Five skeins of wor- 
sted — red, blue, pink, 
yellow and orange. 

Skeins of worsted 
assorted colors. 



d. Musical 
sound . 

e. Form. 



Two wooden cubes, 
cylinders, spheres, 
pyramids, cones and 
parallelopipeds. 



Recite series of nonsense 
syllables. Have subject re- 
peat them. Repeat process 
as many times as proves 
necessary for S. to learn 
them. If 9 syllables are be- 
yond S's memory span, re- 
duce number. 

Have nonsense syllables 
written plainly on cards and 
expose series serially. Have 
subject repeat them. Re- 
peat process until S. has 
memorized the list. If 9 
syllables are beyond S's 
memory span, reduce the 
number. 

1. Show skeins of five 
different colors, then cover 
them and ask S. to name the 
colors he has seen. 

2. Show skeins of five 
different colors, cover them 
and ask S. to pick out five 
like them from a pile con- 
taining skeins of many 
colors. 

Sing or play a few notes 
of a melody, and ask S. to 
reproduce it. 

Show S. cube, cylinder and 
sphere. Cover them and 
show him a group of models, 
among which are duplicates 
of the first. Ask him to 
pick out the models just 
seen. 



EXAMINATION OF CHILDREN 



79 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



I. RETENT- 

IVENESS. 



Nonsense syllables as 
given above. 



Have subject learn non- 
sense syllables by method 
outlined in immediate mem- 
ory tests, and tell him that 
you will ask for a recitation 
on the following day. Note 
how many have been forgot- 
ten in the 24 hours, and the 
number of errors in position 
of series. If impossible to 
see S. twice, give immediate 
memory test early in the 
interview and call for a rec- 
itation of syllables at its 
end. 



80 



A GUIDE FOR THE CLINICAL 



Part 3. Apperception. 



TESTS. 



MA.TERIAL,S 
REQUIRED, 



DIRECTIONS FOR TESTING. 



L PASSIVE 
APPERCEP- 
TION OR AS- 
SOCIATION, 
a. Train of 
thought. 



Narrow strips of pa- 
per (4 in. by 14 in.) 
Lead pencil, stop 
watch. 



b. Word re- 


A 


ist of 100 w 


actions. 


1. 


dog 




2. 


hand 




3. 


ocean 




4. 


friend 




5. 


spring 




6. 


wrong 




7. 


case 




8. 


gun 




9. 


custom 




10. 


enjoyment 




11. 


despise 




12. 


home 



Supply subject with paper 
and pencil anddirect him to 
write a list of words, one 
word on each line; to write 
EVERY word that comes in- 
to his head without pause 
or selection. Impress up- 
on him that he is to make 
no choice of words, but to 
write whatever comes to his 
mind and towriteitasquick- 
ly as he can. Havehimwrite 
for fifteen minutes and note 
his progress at the end of 
each five minute period. 
If S. cannot write have him 
dictate them. The subse- 
quent analysis of such a list 
gives much data onthequal- 
ity and rate of thought, the 
mode of association andmen- 
tal content. Eull. directions 
for such analysis are too 
technical to be given here. 

The wordsareusedasstim- 
uli. S. is instructed that 
when he hears a word he is 
to say AT ONCE the word 
that itbringsup in his mind. 
Beforepronouncingthe stim- 
ulus word a ready signal 
should be given. The reac- 
tion word is recorded also 
the time which elapses be- 
tween the utterance of the 
stimulus word and the ut- 
terance of the response. 



EXAMINATION OF CHILDREN 



81 



TESTS. 



MATERIALS 
REQUIRED. 



DIRECTIONS FOR TESTING. 



13. reward 

14. theatre 

15. clean 
freedom 
yellow 
bird 
money 

20. sleepy 

21. music 

22. blood 

23. dream 

24. plant 
hesitate 
funny 
secret 
number 
beauty 
happy 
tree 

electricity 
man 
jewel 

35. needle 

36. butterfly 

37. time 

38. fire 

39. news 
■iO. crime 

41. picture 

42. copper 

43. death 

44. sport 

45. creator 

46. long 

47. people 

48. silk 

49. medicine 

50. future 
^51. American 

52. poverty 

53. laugh 

54. good 



25. 
26. 
27, 
28, 
29. 
30. 
31. 
32. 
33. 
34. 



For exact time results it 
is necessary to have some 
form of apparatus which 
will mechanically register 
when the stimulus word and 
the response words are ut- 
tered. A satisfactory meth- 
od is to obtain an electric 
response tothespokenwords 
by means of a very delicate 
telephone transmitter and 
relay, a Pfeil signal record- 
ing onaKymograph. A time 
line simultaneously marks 
on the Kymograph. 1-10 
seconds intervals. For less 
exact time results a stop 
watch recording 1-5 seconds 
is used. This is a crude and 
inaccurate method, but is 
often useful when access to 
a laboratory and appropri- 
ate apparatus is impossible. 



82 



A GUIDE FOR THE CLINICAL 



TESTS. 



MATRRIALS 
REQUIRED 



DIRECTIONS FOR TESTING. 



55. 


recreation 


56. 


lover 


57. 


country 


58. 


above 


59. 


ship 


60. 


dance 


61. 


constant 


62. 


table 


63. 


coat 


64. 


business 


65. 


pain 


66. 


stupid 


67. 


work 


68. 


youth 


69. 


knife 


70. 


lily 


71. 


power 


72. 


face 


73. 


Christian 


74. 


forget 


75. 


meeting 


76. 


key 


77. 


innocent 


78. 


mother 


79. 


square 


80. 


loss 


81. 


travel 


82. 


suggestion 


83. 


nurse 


84. 


true 


85. 


danger 


86. 


success 


87. 


name 


88. 


story 


89. 


hypnotist 


90. 


late 


91. 


nature 


92. 


tired 


93. 


grow 


94. 


call 


95. 


life 


96. 


drink 



EXAMINATION OF CHILDREN 



83 



TESTS. 



MATERIALS 
REQUIRED. 



c. Emotional 
reaction. 
(1.) Superfi- 
cial. 



(1.) Physio- 
logical 
changes 
accompany- 
ing emotional 
states. 



2. ACTIVE 
APPERCEP- 
TION. 

a. Sustained 
attention to 
intellectual 
work. 

b. Voluntary 



97. marriage 

98. trick 

99. crowd 
100. woman 

Time recording appa- 
ratus : 

(1.) Chronoscope. 
(2.) Kymograph, me- 
tronome with electric 
contact, set to make 
contact every 1-10 sec- 
ond. (3.) Stop watch 
ne Telephone connec- 
tions for use with ei- 
ther chronoscope or 
Kymograph, two Pfeil 
signal. 

Pictures designed to 
provoke mirth, sor- 
row, sympathy, anger 
and fear. 

Phethysmograph 
Sphygmograph 
Pneumograph 
Kymograph 
Rubber tubing, tam- 
bours, Pfeil signal and 
other accessories. 



DIRECTIONS FOR TESTING 



12 columns of ten one 
place numbers. 



Similar materials as 



Show pictures and note 
emotional reaction as be- 
trayed in facial expression, 
speech and manner. 

Secure Phethysmograms, 
sphygmograms and pneu- 
mogramsfrom subject while 
he is experiencing some 
emotional excitement, and 
note character of curves, 
comparing with those ob- 
tained in passive state. As 
these tests can only be made 
by one experienced in the 
technique of such experi- 
mental work, description of 
method is not given. 

Direct subject to add 
columns as quickly as possi- 
ble. Record time and errors. 

Repeat former tests read- 



84 



A GUIDE FOR THE CJJNIGAL 



TESTS. 



MATERIALS 
REQUIRED. 



DIRECTIONS FOR TESTING. 



attention. 



c. Attention 
to disparite 
activities. 



d. Discrimin- 
ative atten- 
tion. 



e. Active im- 
agination. 



(1.) 
tic. 



Linguis- 



tliose used in previous 
tests. 



Some reading matter, 
paper, pencil, and 
stop watch. 



A. blanks. These con- 
tain lines of printed 
letters, arrangedwith- 
out definite order and 
contain among them 
100 A's. 

QRST. Blanks. 

(Stoelting & Co., 
Chicago.) 

Prepared blanks con- 
taining mutilated 
texts, (words and parts 
of words omitted.) 
(Stoelting & Co., Chi- 
cago.) 



ingor talking to subject while 
he is counting. Record time 
and errors and compare with 
the results of previous ex- 
periment. 

Direct subject to read aloud 
for 30 sec. Record number 
of words read, thenhavehim 
read for same length of time 
new matter of same degree 
of difTiculty and write sim- 
ultaneously as many a's as 
possible. Continue this pro- 
cess using new reading mat- 
ter each time, and each time 
adding oneormorelettersun- 
til subject's limit is reached. 
Record number of errors 
made in the writing and 
number of words read. Sub- 
ject must read and write 
continuously, not write in 
pauses of reading. It is 
possibleto write the wholeal- 
phabet without error and 
without pause in reading. 

Give subject blank and 
direct him to mark out with 
pencil every A. Record time, 
errors and omissions. 



Same directions, 
tuting qrst for a. 



substi- 



Give subject blank and 
direct him to fill in omissions 
as quickly as possible. Re- 
cord time and errors, also 
note confidence and intelli- 
gence. 



EXAMINATION OF CHILDREN 



85 



TESTS. 



l2.) 
tion. 



Inven- 



f. Reason. 



MATERIALS 
REQUIRED. 



Three words: citizen, 
horse, decree, (nounsj 
Remember, put, depart 

'verbs). 



Problem : A man has 
five short chains of 
three links each. 

Show how he can put 
these five pieces to- 
gether into one long 
chain by using only 
three weldings. 

Five wire chains of 3 
links each. (Terman.) 

(1) 9xx) 4xxx4x7 (xxxx 
x9xx 



xlxx 
4xx5 



2x7y 
XXX 4 

xOx 



/ 
\ 


/ 


\ 
/ 



DIRECTIONS FOR TESTING. 



Write as many sentences 
containing the three words- 
citizen, horse, decree, as is 
possible in five minutes. 

The same, substituting 
remember, put, depart. The 
three words must appear in 
each sentence. 

Place before S. the five 
small chains. Have him solve 
problem. Record time and 
stages of process. 



Have subject solve prob- 
lem, supply numbers for all 
the x's without changing any 
of the given figures. Record 
time and method of proce- 
dure. 



Direct subject to trace this 
figure without taking pencil 
ofl" or over a line twice. Note 
time and number of failures, 
also method of procedure. 



86 



A GUIDE FOR THE CLINICAL 



TESTS. 



MATERIALS 
REQUIRED. 



DIRECTIONS FOR TESTING 



(3.) Problem: A ball is 
lost in a round field 
where the grass is so 
tall that you can only 
see ten feet on each 
side of you. Show 
what path you would 
take in looking for the 
ball. 

(Terman). 
Pencil and paper. 



Direct subject to solve 

problem illustrating his 

findings. Record time and 
method. 



EXAMINATION OF CHILDREN 



87 



Part 4. Volitional Motor Ability. 



TESTS 



MATERIALS 
REQUIRED 



1 . CONTROL 

OF MUSCLES 
WHILE IN 
FIXED 
POSITION 
a. Body. 



b. Hand and 
arm. 



Ataxiograph. 



Steadiness tester. 
(Whipple) 

Kymograph and con- 
necting apparatus. 



DIRECTIONS FOR TESTING 



A skuH cap topped with a 
light board on which is 
fastened a sheet of paper is 
placed on the head of sub- 
ject. He then stands under 
a projecting metal rod to 
which is fastened, pointing 
downward a pencil. The 
height of rod is adjustable 
and must be fixed for each 
subject at such a height that 
the pencil point just touch- 
es the paper. S. is instruct- 
ed to stand perfectly still, 
and any swaying will be 
traced on paper. Time of 
test 60 seconds. 

Instrument consists of a 
brass plate pierced by nine 
holes, varying in size. Sub- 
ject holds a metallic needle 
in holes during a period of 
15 seconds. The instrument 
is so connected with electric 
sounder and writing lever 
that each time the needle 
touches the rim of hole, a 
sound is made and the lever 
records on the revolving 
drum of a kymograph. Be- 
gin with largest hole and 
test control first with right 
hand, then with left, allow 
30 seconds rest, then repeat 
with next size hole. Con- 
tinue until a hole is reached 



88 



A GUIDE FOR THE CLINICAL 



TESTS 



MATERIALS 
REQUIRED 



2. ACCURA- 
CY OF 
MOVEMENT: 



Prepared blanks con- 
taining ten crosses 
irregularly arranged. 

(Whipple) 

Metronome. 



3. STEADI- 
NESS OF 



1. Tracing board. 
(Whipple). 



DIRECTIONS FOR TESTING 



which is the limit of S's 
ability, .This instrument 
may be used to test control 
of arm and hand, or hand 
alone by varying position of 
arm and supporting it at 
various points. 

Mount blanks on board 
with name space in lower 
right hand corner and hang 
it on wall in a line with S's. 
shoulder. Let S. stand with 
right shoulder in front of 
target at such a distance 
that his pencil just touches 
target when his arm is ex- 
tended. Set metronome at 
69 and tell S. he is to strike 
at target in time with the 
beat of the metronome, 
striking on one beat, bring- 
ing back pencil until it. 
touches shoulder on next 
beat, then striking again. 
He is to aim at each cross 
once beginning with the one 
in upper left hand corner 
and continuing in regular 
order until tenth is reached. 
This process is twice repeat- 
ed, but in the second round 
the order is reversed. Re- 
peat process with left hand 
using a fresh blank. Meas- 
ure errors with mm. rule 
and And the averages and 
mean variations. S. should 
be given a little practice be- 
fore experiment is begun. 

On tracing board are two 
strips of metal placed to 



EXAMINATION OF CHILDREN 



89 



TESTS 



MATERIALS 
REQUIRED 



DIRECTIONS FOR TESTING 



MOVEMENT. 



4. RATE OF 
MOVEMENT. 



Kymograph and con- 
necting apparatus. 



?. Maze blanks, (Col- 
umbia University.) 



Telegraph key. Two 
Pfeil signals, Seconds 
pendulum or other 
apparatus so arranged 
as togiveelectriccon- 
tact once a second or 



form narrow slit between. 
Metallic stylus is held in 
hand, wrist and arm unsup- 
ported, S. draws a line with 
it on the glass between strips 
of metal. The instrument 
is so connected with electric 
sounder and writing lever, 
that each time the stylus 
touches the metal a sound 
is made and a record made 
on the kymograph. Nine 
seconds are allowed for com- 
plete tracing. Allow three 
preliminary trials to accus- 
tom S. to the rate of move- 
ment desired. As soon as a 
contact is made, S. stops, and 
begins again with other hand. 
Five trials are made with 
each hand. Movements may 
be made toward or away 
from the S. from right to 
left, or from left to right. 
Variations in test may be 
made by supporting arm at 
elbow or at wrist. 

In using Maze blanks, have 
S. draw a line between the 
parallel lines on blank. The 
line must be continuous and 
be a free arm movement. 
Record number of times 
line touches either printed 
line. 

Seat subject at table, let 
forearm rest comfortably on 
the table and hand be in 
position to tap telegraph 
key. Have key connected 
with Pfeil signal in such a 



90 



A GUIDE FOR THE CLINICAL 



TESTS 



MATERIALS 
REQUIRED 



5. FATIGUE 
MUSCULAR. 



oftener. 
Kymograph. 



Ergograph, kymo- 
graph, metronome. 



DIRECTIONS FOR TESTING 



manner that at every tap a 
record is made on the re- 
volving drum of Kymograph. 
Have pendulum connected 
with other signal in such a 
way that a record is made 
every second. The combin- 
ed records will show how 
many taps are made per 
second. Have S. tap for 30 
seconds. Test both hands, 
having S. use index finger. 

Place right arm of subject 
in arm rest adjust weight to 
suit subject, choosing one 
which is quite heavy for him 
to lift (7 per cent of sub- 
ject's weight is given by 
Whipple). Set metronome 
to give one stroke per sec- 
ond and instruct S. to pull 
weight up on one stroke and 
release it on the next. This 
will give one lift in two sec- 
onds. Instructs, to continue 
until he is unable to pull 
weight. Let him rest 5 min. 
andrepeatprocess,rest.5min. 
more and repeat again. The 
writing lever of the ergo- 
graph registers the extent 
of each pull on the revolv- 
ing drum of the kymograph. 
The extent is also measured 
by the endless tape attached 
to ergograph. Multiplying 
the weight used by the tape 
record will give the amount 
of work done, and the graph- 
ic record will show the rate 
of fatigue. 



EXAMINATION OF CHILDREN 



91 



TESTS 



6. REACTION 
TIME. 

a. Simple re- 
actions. 
(1.) Light. 
(2.) Sound. 
(3.) Touch. 
i-i.) Electri- 
city. 



b. Compound 
reactions. 
(1.) Discrim- 
ination. 



(2.) Choice. 



(3.) 
tion. 



Cogni- 



MATERIATjS 
REQUERED 



DIRECTIONS FOR TESTING 



Chronoscope. 
Apparatus for produc- 
ing stimuli of the 
kinds noted. 
Telegraph key. 



Apparatus for producing 
stimuli, and the telegraph 
key are connected with 
chronoscope in such a man- 
ner that chronoscope begins 
to record when stimulus is 
produced and ceases when 
reaction is made. Thus a 
reading of the dial will give 
time that has elapsed be- 
tween production of stimu- 
lus and S's reaction. Two 
signals are given before 
production of stimulus, 
"Ready" to warn subject to 
attend and "Now" immedi- 
ately before presentation. 
The reaction consists in 
pressing telegraph key. 
Subject is directed to press 
key as soon as he perceives 
the stimulus. He is told 
what kind of stimulus will 
be presented. 

DISCRIMINATION. Sub- 
ject is told that either of 
two stimul i, will be given, and 
that he is to react to one on- 
ly which is designated. For 
instance either black or 
white will be shown and he 
must react only to white. 

CHOICE. Subject is told 
that either of two stimuli 
will be given, that he is to 
react to both but with differ- 
ent fingers, for instance if 
white appears he is to touch 
key with first finger, if black 
with second. 

COGNITION. A more com- 



A GUIDE FOR THE CLINICAL 



92 



TESTS 


MATERIALS 
REQUIRED 


DIRECTION FOR TESTING 




' 


plicated stimulus is given 
for this, a word or something 
which S. will have to iden- 
tify. He is directed not to 
touch the key until he iden- 
tifies stimulus. 




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1 




HIPP CHRONOSCOPE 

Used in Reaction Time Experiments. Unit of Measurement i-iooo Sec. 




Group of Apparatus used in recording the psycho-galvanic re- 
action. It includes a galvanometer, hand electrodes, and 
resistance box; also lantern, scale and mirror by which 
movement of coil is magnified and measured. 



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